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Many perimenopausal and menopausal women seek help for unusually heavy or irregular vaginal bleeding. While not all abnormal bleeding is a sign that something is wrong, only your doctor can determine if it is a cause for concern. Below are answers to some commonly asked questions about abnormal vaginal bleeding. If you’ve been experiencing unexplained bleeding, see your doctor to be sure you aren’t at risk for a serious disease.

When is vaginal bleeding considered abnormal?

Bleeding is abnormal if you have very heavy or prolonged periods, if you spot between periods or if your bleeding patterns become erratic. It’s not unusual for women in perimenopause, the period before menopause, to experience irregular menstrual cycles, although they may still require treatment. Any bleeding after menopause should be checked out by your doctor.

My period is usually very heavy. Should I be concerned?

Your period can be heavy but still considered normal. (Normal menstrual cycles produce a total blood loss of anywhere from four tablespoons to one cup.) One in 10 women report excessively heavy bleeding, a condition known as menorrhagia.

What causes abnormal bleeding?

Hormonal imbalances and uterine fibroids (noncancerous growths that develop in the uterine wall) commonly cause abnormal bleeding. Other causes include polyps (small, benign growths on the uterine wall), ovarian cysts, miscarriage, infections, medications, sexually transmitted diseases, problems with intrauterine devices (IUDs) and dysfunctions of the ovaries or the uterine lining. Cancers of the uterus, ovaries and cervix can also cause excess bleeding.

I’ve gone through menopause but still have occasional spotting. Why?

Some menopausal women experience spotting for years after they’ve stopped having regular periods. Hormone replacement therapy can trigger this spotting; your doctor may resolve it by adjusting your dose. You should also be evaluated for gynecological cancers, but your spotting could be due to one of the benign conditions listed above.

How is abnormal bleeding treated?

The cause and severity of your bleeding, your age and your desire to become pregnant will determine the type of treatment you receive. Your doctor may prescribe hormones or recommend nonsteroidal anti-inflammatory drugs, like ibuprofen, to control bleeding. If you have fibroids or polyps, you may need surgery.

Will I need a hysterectomy?

Hysterectomy (removal of the uterus) has been used for years to treat abnormal uterine bleeding. It can save your life if you have cancer. To treat a noncancerous condition, your doctor may suggest another option, such as endometrial ablation, a procedure that uses heat, cold or electrical energy to destroy the uterine lining and stop or reduce the bleeding.